A comparison of renal cell carcinoma with tumor thrombus across North America, Central/South America, and South Korea

Purpose: With multi-institutional collaboration, the purpose of this study was to analyze geographical differences of renal cell carcinoma with tumor thrombus between patients in North America, Central/South America, and South Korea. Materials and methods: Patients with renal cell carcinoma and a tumor thrombus who underwent nephrectomy plus thrombectomy were retrospectively analyzed. Patients were from North America, Central/South America, and South Korea. All comparisons were done based on the region where a patient had their surgery and follow-up. Chi-squared test, analysis of variance, Kaplan-Meier survival with log-rank test, and Cox regression analysis were used. Results: A total of 478 patients were included, 212 from North America, 209 from Central/South America, and 57 from South Korea. Of note, thrombus level was different using the Neves classification system between regions (p < 0.001), with a greater thrombus level in Central/South America. Surgical approach differed, with laparoscopic cases done most often in Central/South America and robotic in North America (p < 0.001). Tumor grade was lowest in South Korea (p < 0.001) and stage (p < 0.001) greatest in Central/South America. Overall survival was greater in South Korea compared to Central/South America (p = 0.026). Cancer-specific survival was greater in South Korea relative to North America and Central/South America (p = 0.026). Conclusions: Patients from North America, Central/South America, and South Korea diagnosed with renal cell carcinoma and tumor thrombus do not present the same and have different outcomes peri-/post-operatively. This includes important variables which have impacts on patient morbidity and mortality. Considering increased efforts on health equity in urology, the causes of these differences call for further investigation.